Seeing is believing

In the world of policy and research, the case study is one of the key ways in which we communicate new ideas, and innovative projects. But when it comes to other organisations learning from these innovations, there’s nothing quite like visiting the projects and meeting the people involved, to really get under the skin of it and ask the questions that help to make it relevant to your own work.

So, as part of our work with Nesta and the Innovation Unit’s People Powered Health Programme (PPH), nef has been facilitating study visits for people working in health and developing co-production, to other innovative projects in healthcare which have been developing the approach. The Croydon Service User Network (S.U.N) and Paxton Green time bank are both models which we wrote up in a Catalogue of Co-production to share learning on co-production within healthcare. You can read both these case studies in the report itself.

S.U.N. is a peer network for people with personality disorders and difficulties. Members of the network support each other formally through group sessions, and informally outside of them, to develop their confidence and expertise in managing crises. Using their own experience they are able to support others through crises, and build collective knowledge on coping mechanisms. There are over 70 members of Croydon S.U.N, and there are four weekly meetings – although members might usually attend one or two. The group are supported by facilitators who are skilled professionals with a range of backgrounds, including nursing, occupational therapy, counselling and others.

Fifteen of us associated with the PPH programme heard from clinical staff, a number of S.U.N. members, and two facilitators. The personal testimonies of members were hugely moving in making the case for more low level, mutual support, and the value they get from supporting others, as well as receiving support themselves. A number of interesting features of the S.U.N. approach were brought out, including;

The network meets in the Croydon Voluntary Action Centre, instead of being based in a mental health building or service. This is a critical part of what makes it accessible, and provides a neutral space for the members to come together with the facilitators.

When the clinical team were thinking about setting up S.U.N., they were clear that ‘‘we didn’t want to impose something on people’’. They recruited and worked with a local service user led group, who helped shape the initial ideas for the network, and agreed the ground rules for the group. This move was critical in setting the tone for the way the group would work. One member pointed to the difference this makes in comparison to other services: ‘‘I do find it refreshing to work with professionals who don’t think they know best’’.

The barriers to entry into the network are very low, and it can be recommended to anyone who has a personality disorder, or people can self-refer in. Membership of the network is not time limited, and members determine for how often, and how much, support they would like. ‘‘We don’t ever discharge anyone from SUN’’. This means it provides the opportunity for people to access long term support, without it having the boundaries, eligibility criteria and exclusions of a ‘service’.

The role of the facilitator is very important, but different from that of more typical clinical support, which might be professionally led. Members were clear that ‘’facilitators don’t run the group, but do provide direction and guidance’’.

The Croydon S.U.N. project has been gathering data on the effectiveness of support for members, which includes an impressive 30 per cent reduction in A&E attendance, while bed use in hospitals has dropped by over half. Despite this shift of resources from acute to community based they still face challenges in securing investment to replicate the approach in other areas. In the current climate of austerity, investment in new support often requires a cut in another aspect of the service.

Paxton Green Time Bank was the next stop for the afternoon study visit. The time bank was started by a doctor who was inspired by a similar approach at the Rushey Green GP practice, and wanted to support the development of a similar, community based approach to supporting health and well-being, and tackling challenges such as social isolation. Once again, we heard from a number of time bankers who were able to bring the approach to life, and really helped us get under the skin of how the time bank was creating a different culture of health and well-being support in the area. Some of the specific questions people had included;

The way the time bank links in with the GP surgery: the time bank is housed in a local community centre, but regularly runs sessions and has a strong presence in the surgery, which is just five minutes down the road. GPs at Paxton Green can refer people to the time bank if they think they would benefit from it, particularly those for whom social isolation is a problem. The time bank also advertise within the surgery and receptionists can make people aware of it, so that people can self –refer.

The time bank is actively building knowledge and expertise among its members about health and well-being within the community and has worked with both time bank members and external experts to give talks on physiology, diabetes, COPD and other aspects of health.

The challenge of scale and sustainability: some of the people on the visit raised the question of whether time banks should be focussing on developing sustainable sources of income to support their work, or if they should remain focussed on creating space for local relationships and networks to flourish. A lively discussion followed, emphasising the value of critical reflection and discussion when people are refining their own ideas, and learning from others who are pioneering innovation.

Safeguarding: while many public agencies are anxious about the potential safeguarding implications of more community based support, Paxton green only CRB check where absolutely necessary, for example where someone might be reading to a group of children. They reminded us that ‘’you wouldn’t CRB check your neighbour’’, and try to keep their focus on creating the space for relationships to develop informally, and outside ‘services’.

These visits really stated the importance of face to face discussion and peer learning among people looking to innovate within public services. More than having that question answered, people left inspired by the energy and enthusiasm of the groups they had seen who were getting on and making change happen. This injection of energy is something we’ll – sadly, never be able to convey in a report.